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CMS-1403-FC
that rule, the Government Accountability Office (GAO) has
published a study indicating the overuse of some diagnostic
testing when performed in a physician’s office. The GAO
report, Rapid Spending Growth and Shift to Physician
Offices Indicate Need for CMS to Consider Additional
Management Practices, (GAO-08-452), showed that spending
for imaging services paid under the PFS more than doubled
over a 6-year period from 2000 through 2006. The report’s
findings reflect a link between spending growth and the
provision of imaging services in physician offices. The
proportion of Medicare spending on imaging services
performed in-office rose from 58 percent to 64 percent and
physicians received an increased share of their total
Medicare revenue from imaging services. We recognize that
not all arrangements necessarily lead to overutilization.
However, we are not able to regulate per individual
practice and instead must issue rules of general
applicability to implement statutory intent and address our
concerns regarding the potential for overutilization
through unnecessary diagnostic testing.
b. Statutory Authority
Comment: A commenter noted that the anti-markup
provisions in section 1842(n)(1) of the Act are limited to
“diagnostic tests described in section 1861(s)(3) [of the
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